DSL and spiders

Started off the day today with the first return visit to one of the puskesmas where we've been doing the HIV testing and counseling program. It was nice to see the staff there - I just hung out with the staff while 3 of the staff did one-on-one posttest counseling with the pregnant women. I won't reveal which ones, but there are at least two cases of women who we've found to have HIV at the various community clinics, so there is some tension behind the lighthearted visits.

Later in the day, helped set up the DSL on the new GC computer. They've never had anything but dialup before. It's great to see how they are using the new computer, which on purpose we're putting in the main back area, so that it will be the staff computer and not associated with one person's desk. The staff really want to build their skills in using the computer and the Internet, so this is all very exciting.


In the evening, I went to a kelompok diskusi way on the outskirt of town, almost all the way to the airport. We went down a little dirt road in the dark - felt like being in a village. A very run-down home but a group of really nice waria. We had a great discussion. All the while I kept looking up at the opposing wall - up high was a giant spider - about 6 inches across. There are bird-eating spiders in Sulawesi - this might have been a small version of one? Of course, funny thing is the the black widows and brown recluses back in Long Beach are much more dangerous.

House visits

Today in the afternoon I went along with a GC staff member to make house visits to two persons living with AIDS who can't make the support group meetings at this time. It was a sobering experience - I've met and supported folks who were pretty sick before, but it's still hard. In both cases the men in question are supported almost entirely by their mothers, who in both cases are very brave and understanding. The men are both former injecting drug users. One is really having trouble eating - the antiretrovirals are causing lots of nausea and vomiting. Ade (the staff person) did a great job helping the mother figure out how to navigate the health care system here to try and get some better answers and perhaps modification of the medication. This guy was really thin and weak - I could see him struggle to breathe as he sat with us, and even talking was an effort. The drugs are making his arms itch too. He's dealing with tuberculosis and hepatitis C at the same time - it's very hard.

The second person comes from a wealthier family which helps, but he's if anything in worse condition. As in the first case, a mother who's a widow who's really caring and supportive. GC is in the process of setting up a support group especially for parents of people living with AIDS - both of the mothers think that would be great to share experiences and tips. This second guy is not having trouble eating, but some combination of the drugs and opportunistic infections is causing horrible, horrible dry peeling skin (at least 1/4 inch thick) on his arms and legs. His feet almost looked like sponges. It's frustrating because they've been going to lots of skin doctors but no luck as yet. And because of this, the person is not really seeing anyone, and he used to be quite active, so people are worried the isolation is making things worse. The mother greeted us and then we used the arrival of an American as an excuse - the mother went into his room and finally he came out. Ade was so happy because this is the first time in a long while that he's seen anyone other than his family. It was good to offer him support - he's having vision problems too.

All this just drives home the point that GC's work is so important, and that there's a need for continued efforts in both treatment and prevention.

Mami Ria

Among other things today, we had our first real official English class which was a hoot. Also the computer we ordered yesterday got delivered (I helped pay for it, just a couple hundred dollars but it makes such a difference to them). Hopefully the DSL will be up and running by tomorrow. Then in the evening, after a nice dinner of coto (Makassarese speciality, beef soup kind of thing), went with 3 friends to go see Mami Ria, who's one of the main community leaders for waria in Makassar (in the whole region, really) and who Bill and I know well! She said her hellos to Bill and we spent a couple hours on the side of the road next to her salon sitting in chairs and talking in the cool(er) night air, eating fried jackfruit and just having a good time.

Testimony

Last night, I got to participate in an amazing kelompok diskusi - the first I attended where we had someone with HIV come and give testimony. It had a powerful effect on people - to see that someone "like them" could be infected, and be healthy if they get on the antiretrovirals. A very interesting evening. The person giving testimony even pulled out the pills to show people what they were like, and talked about the importance of getting tested.

The AIDS support group

Had a nice day working in the office all day - mostly helping a couple people get in their proposals for the Asia/Pacific AIDS conference before the deadline tomorrow. These kinds of seemingly boring routines can be a gold mine for anthropologists, so it's still quite interesting to me.

Then tonight was something special - attending my first meeting of the AIDS support group. 12 people attending, all living with HIV. Some have an official AIDS diagnosis; a few are taking antiretrovirals, some not - mainly because due to the rationing of the free medications, you have to have a T4 cell count under 200 (which is quite low) to get access to them. Which is interesting in itself of course. I did an HIV 101 discussion and they were transfixed - their access to info is fairly limited. The GC staff know more but a refresher doesn't hurt them either.

I explained how reverse transcriptase and protease work in HIV replication - and how these are the two things that antiretrovirals work against. To explain protease I ran into the next room and came back with a pair of scissors, pretending to cut myself to show how T4 cells infected with HIV use protease to disassemble themselves to make new HIV unless there's a protease inhibitor. Folks wanted an explanation of resistance and don't ask me why, but what came to mind as an allegory was shooting rabbits in your yard and if you don't kill them all, the ones who don't get shot are probably the smarter ones so their baby rabbits will be smarter and harder to kill. They got it, so I guess it worked!

It was very interesting to see what kinds of questions they asked. Some had to do with injecting heroin, which is sadly really on the rise here and a major engine behind the explosive growth of HIV infections. Others had to do with things they'd read in the newspaper or had been told by quack doctors about "cures" for HIV/AIDS. Very frustrating. I talked about the difference between such false hopes and true hopes - like the potential for effective integrase inhibitors or CD4 blockers that could even represent a cure someday in the future. That was helpful to people.

They are very brave - they know that they have some serious issues to face with their HIV infection, but they are also committed to taking steps to protect their health. Though it's frustrating to see how many of them smoke still - smoking is such a problem here.

The Worst Movie Ever...

Spent the day today helping prepare abstracts and scholarship applications for GC staff hoping to attend the International Conference on HIV/AIDS in the Asia/Pacific this August - it's so complicated and must all be in English, I don't know how most organizations do it. Then tonight went to the mall for dinner and a movie, accompanied by Tiara, a waria friend and staff at GC. Had some nice Indonesian food. Then turned out the movie we'd wanted to see (some Indonesian horror flick) was sold out, so we saw "Badai Pasti Berlalu" (The Storm Will Pass), a romantic flick. It was incredibly cheesy and boring - people were making hilarious comments during the second half of the thing. In the final scene Tiara leaned over and whispered "I think this is the worst film I've ever seen," and I couldn't stop giggling. So a bad film, but a fun evening anyway.

Beach meetings

I had a wonderful time at the strategic planning meeting. We stayed at Tanjung Bunga, a resort beach just 5 miles or so from the GC office. The office rented two beach houses.


We were just 20 feet or so from the beach - beautiful sunsets with all of the little islands out in the Makassar Strait, and lots of ships too.


The beach wasn't the cleanest in the world but it was fine, the water was bathtub warm and very calm (the strait is a pretty protected waterway, nothing like for instance the beaches in south Bali, which face right out to the Indian Ocean).


Saturday night was particularly beautiful. We spent the day doing some really interesting planning for the future of the organization and also to pick a new director (Akbar is going to become more of a chair of the board of directors kind of thing, still coming to the office every day but freer to do more lobbying and training work). Here I am leading a session on HIV updates:


And here I am taking notes in a breakout group working on ideas to improve medical and social care for gay men and warias with AIDS:


Lots of productive discussions--it was a great opportunity to be involved, particularly since I'm one of 4 people currently on their advisory board!





All throughout the 3 days we've eaten wonderful food - lots of fresh fish - looked by a lesbian friend of GC who is an amazing cook.



After the evening session where we picked the new director for GC (Azis, who's been with the organization since 1993 and is an old friend), we went outside to find the quarter moon above the ocean and beautiful white reflections on the waves, with tall pale white thunderclouds too. Distant flashes of lightning every so often, and stars above - it's nice to see the Southern Cross again, and Orion right overhead and the Big Dipper upside down on the northern horizion. A nice cool breeze and the squid-hunting fishing boats out on the water with their strong lights they use to attract the squid looked like a little village out at sea. Saturday night so lots of kids from town on the beach hanging out, playing guitar or chatting. Several of us thought we'd sleep out on one of the bamboo huts, so we just lay there for a long time talking and watching the waves. By about 1am though the beautiful sea breeze was getting stronger and the lightning more frequent - rain was clearly on its way, so we went inside - a good decision because it started pouring rain about 30 minutes later, quite a din on the tin roof of the beach house as I fell asleep thinking of my loved ones eating a sunny breakfast on the other side of the world.